[Activation codes in urgency and emergency care. The utility of prioritising]. / Códigos de activación en urgencias y emergencias. La utilidad de priorizar.

"Time-dependent" pathologies, understood as those in which diagnostic or therapeutic delay negatively influences the evolution and prognosis of a case, are considered to be critical in emergencies, as their morbidity and mortality is directly related to delay in starting treatment. Examples of this type of pathology can be found in normal clinical practice, i.e. cardiac arrest, stroke, trauma, acute coronary syndrome or sepsis. The creation of systems of coordination between care levels involving different levels of complexity has made possible the implementation and, finally, the consolidation of certain procedures agreed upon amongst all health professionals involved in the care process. These procedures, in a spontaneous and generic way, have been defined as "activation codes". The appearance of these codes apparently seems simple, but represents a challenge. On an emergency being detected, the receiving centre appropriate for the patient is warned through an emergency coordinating centre and the patient is taken to that centre. What is sought with the codes is coordinated team work, based on scientific protocols recognised by those involved in care and the scientific community, and avoidance of duplicated actions and unnecessary delays in actions with the patient. In short, their single aim is joint work in the patient's benefit.

Códigos de activación en urgencias y emergencias. La utilidad de priorizar / Activation codes in urgency and emergency care. The utility of prioritising

Las patologías «tiempo-dependientes», entendiendocomo tales aquéllas en las que el retraso diagnósticoo terapéutico influye negativamente en la evolución yel pronóstico del proceso, son consideradas críticas enlas emergencias, ya que su morbimortalidad está directamenterelacionada con la demora en iniciar el tratamiento.Ejemplos de este tipo de patología existen enla práctica clínica habitual, desde la actuación ante laparada cardiorrespiratoria, continuando con el pacienteque sufre un accidente vascular cerebral, un politraumatismo,un síndrome coronario agudo o una sepsis.La creación de sistemas de coordinación entre nivelesasistenciales de diferente complejidad ha posibilitadola implantación y, finalmente, la consolidación de unosprocedimientos consensuados entre todos los profesionalessanitarios implicados en el proceso asistencialque, de forma espontánea y genérica, se han definidocomo «códigos de activación». La aparición de estos códigosaparentemente parece simple, pero se convierteen un reto. Al detectarse una emergencia, se procede alaviso del centro receptor adecuado para el paciente através de un centro coordinador de emergencias y setraslada al paciente a dicho centro.Con los códigos se busca trabajar en equipo, deforma coordinada, basado en protocolos científicosreconocidos por los implicados en la asistencia y la comunidadcientífica y evitar duplicidad de acciones y retrasosinnecesarios en las actuaciones con el paciente.En definitiva, tienen como una única finalidad trabajarconjuntamente para el beneficio del paciente(AU)

“Time-dependent” pathologies, understood as thosein which diagnostic or therapeutic delay negativelyinfluences the evolution and prognosis of a case, areconsidered to be critical in emergencies, as their morbidityand mortality is directly related to delay in startingtreatment. Examples of this type of pathology canbe found in normal clinical practice, i.e. cardiac arrest,stroke, trauma, acute coronary syndrome or sepsis.The creation of systems of coordination between carelevels involving different levels of complexity has madepossible the implementation and, finally, the consolidationof certain procedures agreed upon amongst allhealth professionals involved in the care process. Theseprocedures, in a spontaneous and generic way, havebeen defined as “activation codes”. The appearance ofthese codes apparently seems simple, but representsa challenge. On an emergency being detected, the receivingcentre appropriate for the patient is warnedthrough an emergency coordinating centre and the patientis taken to that centre.What is sought with the codes is coordinated teamwork, based on scientific protocols recognised by thoseinvolved in care and the scientific community, and avoidanceof duplicated actions and unnecessary delays inactions with the patient. In short, their single aim is jointwork in the patient’s benefit(AU)

Effect of intra-aortic occlusion balloon in external thoracic compressions during CPR in pigs.

This study was performed to compare the effectiveness of external thoracic compressions with and without intra-aortic occlusion balloon with capnography and coronary and cerebral perfusion pressure (CPP) in the normothermic and traumatic-less cardiopulmonary arrest provoked by a ventricular fibrillation in pigs. This was an experimental study (cross-over study) in 14 pigs with similar characteristics (23 +/- 2 kg, 10-12 weeks of age). After an 8-minute nonintervention period, the cardiopulmonary resuscitation (CPR) consists of 4 periods of 5 minutes alternating CPR with and without intra-aortic occlusion balloon. Main outcomes measured are end-tidal CO(2) (ETCO(2)); intra-aortic, coronary, and cerebral perfusion pressures; blood gas analysis; and blood lactate concentration. At the end of each period, levels are obtained. Postmortem study was made. Inflation of the occlusion balloon provokes an expansion in the ETCO(2) of about 38%. The coronary perfusion pressure initially goes from 10.21 to 29.0 mm Hg after the occlusion of the aorta, which means an increase of 150%. The CPP goes from 12.54 to 39.71 mm Hg after the balloon was inflated, which means an increase of 200%. In all cases the differences are statistically significant (P <.0001). These increases are less important in the final periods. Intra-aortic balloon occlusion increased ETCO(2), coronary, and cerebral perfusion pressures. An early application of this technique was important.